CMRN MNA Ambulatory Nurse Case Manager Atrius Health at UnitedHealth Group
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CMRN MNA Ambulatory Nurse Case Manager Atrius Health
Auburndale Massachusetts
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CMRN MNA Ambulatory Nurse Case Manager Atrius Health
Requisition number 2339072
Job category Nursing
Primary location Auburndale MA
Date posted 04172026
Overtime status Non-exempt
Travel No
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Explore opportunities with Atrius Health part of the Optum family of businesses. Were an innovative health care leader and multi-specialty group practice delivering an effective connected system of care for adult and pediatric patients at 28 practice locations in eastern Massachusetts. Our entire team of providers physicians PANPs and ancillary clinicians works collaboratively with a value-based philosophy within our group practice as well as with hospitals rehab and nursing facilities. Be part of our vision to transform care and improve lives by building trust understanding and shared decision-making with every patient. Join us and discover the meaning behind Caring. Connecting. Growing together.
Position in this function is responsible for providing on-site transitional care coordination to ensure safe transitions of care and optimal communication between treating facility PatientFamily and Atrius Health. Responsible for coordinating patient transitions from Hospital to home or other care settings ensuring a smooth discharge process and continuity of care
Position Details
Location Beth Israel Deaconess Medical Center located at 330 Brookline Ave. Boston MA 02215
Department Case Management
Schedule 40HRS Weekly M-F 800am- 430pm
Primary Responsibilities
Provides direct referral source servicing at identified facility building and enriching relationships identifying needs problem solving and meeting or exceeding expectations of external customers
Serves as an extension of the Atrius Health practice site connecting with Atrius Health patients andor families to bridge the Atrius Health practice to the patient
Conducts review of the medical record for Atrius Health adult medical or surgical hospitalized patients
Conducts initial assessment of patient within 24 - 48 hours business days of admission
Subsequent reviewprogress note at least every 7 days or accompanying a change in conditionplan
May provide educational andor program material to the site facility staff in compliance with Atrius Health clinical initiatives services and specialty programs
Performs needs assessments of patientsfamilies for services including but not limited to primary care specialty care visits skilled homecare palliative care hospice care including hospice residence andor skilled nursing facility to ensure appropriateness of services and expedite transitions of care
Educates Atrius Health patientsfamilies regarding provider relationships serviced through preferred homecareSNF organizations
Assesses adult medicalsurgical Atrius Health patients for risk of readmission and communicates identified risks with transition of care outpatient case manager andor primary care team Facilitates real-time review of contributing factors to readmission of patients and explores opportunities for acute care hospitalization ACH reduction
Accesses Atrius Health patients Epic medical record to determine current program enrollment for continuation of care
Assesses patients admitted with Heart Failure HF or Chronic Obstructive Pulmonary Disease COPD for HTMRPM and initiates referral to the appropriate program
Initiates a referral to the Atrius health heart failure program when appropriate
Collaborates with hospital-based case manager to facilitate advance care planning documents such as health care proxy or MOLST form
Facilitates communication between patients hospital-based care team and practice based primary care team when needed or requested
Collaborates with transition of care team and hospital-based case manager to ensure post-hospital follow up visit is scheduled
Provides supportive patientfamily education for targeted diagnoses including heart failure diabetes COPD to ensure optimal preparation for home discharge
Coordinates with the hospital-based case manager to facilitate regarding Atrius Health preferred provider networks
Seeks opportunities to improve communication and collaboration amongst all clinical partners in patient care treating facility and internalexternal partners or provider
Collaborates and communicates with Manager and Atrius Health Case Manager to identify and address any issues or concerns
Documentation Maintains accurate records of the discharge planning process in the patients medical record for legal regulatory and billing purposes
Participates in service recovery as needed
Promotes problem identification resolution to barriers in care delivery efficiency productivity and customer satisfaction
Builds relationships with physicians referral sources managed care and assigned facilityies
Provides information resource materials and education to all providers and case managers and solicits feedback
Promotes Atrius Health specialty programs designed to meet the needs of patients providers and partners Assists with other referral source account coverage as needed
Performs other duties as requested
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.
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Caring. Connecting. Growing together.
Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:
• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. Learn more about what we offer.
• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. Learn more about our culture.
• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. Discover all the ways you can learn, grow and develop.